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Discussion #1

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As a nurse myself, I have experienced first-hand the struggles of the shortage. My first experience was that of a student and that was nearly 15 years ago. The community college that I started my nursing education with was in El Paso, Texas. It was very difficult to be able to get accepted into the program because they only offered 35 slots and entrance was only given every two years. You had to compete with your GPA in the non-nursing courses, write an essay to the nursing faculty, and pray you got accepted. This was because of the nursing shortage. There were only three instructors and these 3 women taught every single class. Not enough faculty members to teach were one of the reasons for the shortage at that time. 
Now let’s fast forward a few years. With a move to a new city and state I made a career and educational move as well. I completed my Bachelor of Science in Nursing and eventually became a Director of Nursing (DON) at a 120-bed nursing home. As the DON, one of my main responsibilities was staffing the home. Pynes & Lombardi (2011) discuss some common mistakes that new managers make when it comes to the interview process. They identified exactly what was happening to me in that I had “several openings and a short time in which to fill them (Pynes & Lombardi, 2011.) Of course, I had some problems, but through prayer, trial and error I learned how to be more selective. James 1:2-3 (NKJV) says “My brethren, count it all joy when you fall into various trials, knowing that the testing of your faith produces patience.” What I found in my interviewing of potential staff was that there were not a lot of candidates applying, the pay was low, and the nurse-patient ratio was extremely high. 
The facility I worked for focused on the numbers.  Are there enough “licensed bodies” in place to provide the nursing hours that were required by the state? That was the bottom line. Seventy-five percent of the time I was forced to hire a nurse that I felt was unqualified for the position. I was uncomfortable with hiring a nurse who had no experience working with the elderly. I had concerns about their assessment skills of an older adult patient. I wanted nurses who could provide quality care. The administrator wanted nurses who could help meet the nursing hours. There was no motivation in investing in staffing quality nurses when reimbursement was still given whether providing care at the minimum levels versus care at a higher level of excellence (Fox & Abrahamson, 2009.) I remember the administrator keeping an unqualified nurse on staff that had made several serious mistakes simply because “she was the only nurse available to cover a shift on short notice.” The nurse had not checked on a resident at all during her 12 hour shift and discovered him dead in his bed the next morning when she went in to check his blood sugar. The resident was a full code and CPR was not initiated. The main focus for the administrator was only to meet the required nursing hours for the day regardless of the skills of the nurse. 
Ferguson & Lloyd (2017), argue that staffing is not just important when providing healthcare, but “safe staffing is critical for positive patient and population outcomes.” High acuity patients require more nursing care than those that are low acuity. As a young nurse fresh out of nursing school I was very interested in cardiac care. I began working at the local hospital of which I worked as a Student Nurse Tech (SNT) while in nursing school. As a SNT we worked alongside the licensed Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs) in order to gain experience. As an SNT you pretty much worked wherever you were assigned. One evening I came on shift and discovered that it was just myself (the unlicensed student) and one RN working on the cardiac step-down unit with 13 patients. The normal staffing ratio would include 1 RN, and LVN, and a nursing assistant. With the type of critical patients on the unit the RN was very frustrated because these patients are all mid-level to high acuity. This was unsafe for the RN whose license I worked under and the patients we were caring for. At this time acuity-based staffing solutions were not being used. Ferguson and Lloyd (2017) see acuity-based staffing as a means to help with decision-making when it comes to admissions, transfers and discharges. Nursing informatics is a field that is focusing on these types of issues. Even in my two year working as a DON, I was faced with the same problem. Having residents on mechanical vents, tube feedings, frequent blood sugars with minimum staffing becomes frustrating and sometimes unsafe. Taking control of admissions, discharges, and transfers in a systematic manner could have prevented one nurse from having so many high-acuity patients.
The final contribution to the nursing shortage is low pay when compared to other professions. The nurses at the nursing home back then only made $12.75 an hour. The hours were long, the work was hard, and the stress level was high. When it was time for annual evaluations, the nurses were only given a raise of 10 to 25 cents more an hour. Instead of being given time off to take a vacation, which most could not afford to do, they are given a check to the equivalent of one week of their pay. I lost most staff to the local hospitals because the shortage was so bad that they began offering $5K bonuses to attract nurses to come and work for them. When employers began offering student loan repayment and tuition vouchers, Fox and Abrahamson (2017), argue that this method of recruitment made it so much easier for employers to offer a low wage. Most of the nursing in my graduating class, including myself, were offered bonuses for 1-2 year commitments. I gave the cardiac unit 1 year and only stayed that long so I did not have to repay the bonus. I left because of poor staffing on a unit with such critical patients.
My recommendation to ratify the nursing shortage would be for nurses to be able to specialize, maybe in their final year of the baccalaureate program, in the particular field as to which they want to work. As a student, you go through each area, pediatrics, mental health, medical-surgical, obstetrics, etc. If in your final year you got to learn more about the one you really fell in love with, that would keep you interested, and maybe not burn out as fast. I also recommend alternate work schedules. Even in administrative nursing we are still at a shortage. We desire to get the work done, but cannot always do it within the confines of the office, or structured work day. My next recommendation would be free continuing education for current nurses that wish to train in other areas. There are so many technological advances out right now and things change such as new medical equipment, new ways to perform a procedure. I would like to be able to explore those things as a way to market myself for other opportunities to learn new nursing skills.
Fox, R. L., & Abrahamson, K. (2009). A critical examination of the U.S. nursing shortage: Contributing factors, public policy implications. Nursing Forum, 44(4), 235-244. doi:10.1111/j.1744-6198.2009.00149.x
Ferguson, S. L., & Lloyd, J. (2017). Innovative information technology solutions: Addressing current and emerging nurse shortages and staffing challenges worldwide. Nursing Economics, 35(4), 211
Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. San Francisco, CA: Jossey-Bass.

 Discussion #2 

Depending upon what research a reader would apply to understanding where the national shortage of both physicians and nurses comes from: be it one factor, or combination of factors the result is the shortage is rampant and ongoing. For the past two decades in both the United States and Canada the economy experienced colossal shortages across the health care profession ranks. (Pynes & Lombardi, 2011,).
Directly pinpointing physicians as a focus I chose to deduce the physician shortage to a combination of factors beginning with the fundamentals of math. From a simple ratio perspective assuming a traditional model outlook of patients being care for by a single physician, there is one physician for every 2,500 patients. The odds of achieving and maintaining a balanced physician –to-patient ration would be difficult. (Green Savin, & Lu, 2013).
Another factor of area to consider which directly contributes to the national physician shortage “is the gap between the adult populations demand for primary care services and the capacity primary care (Bodenheimer & Smith, 2013).” The unmatched physician –to-patient perspective details the concept of the patients access to timely care in taking in account various degrees of patient demand and arrival of patients requests that in joining patients demands, visits and time spent with each patient the result would be a severe backlog and the inference of quality of visit with physician.
Another factor of area to consider which directly contributes to the national physician shortage “is the gap between the adult populations demand for primary care services and the capacity primary care (Bodenheimer & Smith, 2013).” The demand is greater than the physicians avaliable to supply the need a strategy of offset must be looked at a way to supply for patient needs. Strategies to rectify the physician employment issue specifically the physician –to-patient ratio issue would be implementing teams, non-physicians, and electronic communication to counter the ratio issue. Presumably by creating teams of care and have the non-physicians support the physicians more consistent amounts of patients can be seen per day. By increasing electronic communication would minimize the face-to-face appointment and the time saved could be devoted to quality physician visits.
 Additional strategies to suggest to rectify the employment issue of physicians would be efficiently use all personnel staffed in the capacity of health care professionals. That means empowering nurses and pharmacists who fall under licensed personnel to provide more care. Also that means instating standing orders for all for medical assistants who fall under nonlicensed health personnel to function in higher required needs of health coaches to provide preventive care needs. (Bodenheimer & Smith, 2013).” By utilizing all health care personnel available there is more time for the team of professionals to take care of the needs of the patients. If additional hiring needs to take place health care human resource departments are adamant is correct placement.
Ensuring the overarching goal is reached which is to hire physicians who “would contribute to the progressive improvement of performance across the organization (Pynes & Lombardi, 2011, p. 178).” Biblical integration can be related to Acts 20: 35 which read “In all things I have shown you that by working hard in this way we must help the weak and remember the words of the Lord Jesus.” By analyzing and finding all strategies that result in heightened patient access and quality care would be working hard in the way in which the book of Acts describes. As medical services abilities and what is being offered to the consumer has grown facilities and support capabilities of delivering services has not which directly correlates to the workforce manning one being able to keep up with the demand and provide the services in a timely manner.
References
The Holy Bible, English Standard Version. (2016).
Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. San Francisco, CA: Jossey-Bass. ISBN: 9780470873557. Green, L. V., Savin, S., & Lu, Y. (2013). Primary care physician shortages could be eliminated through use of teams, non-physicians, and electronic communication. Health Affairs, 32(1), 11-9. Retrieved from http://ezproxy.liberty.edu/login?url=https://search-
proquest-com.ezproxy.liberty.edu/docview/1285127946?accountid=12085
Bodenheimer, T. S., & Smith, M. D. (2013). Primary care: Proposed solutions to the physician shortage without training more physicians. Health Affairs, 32(11), 1881-6. Retrieved from http://ezproxy.liberty.edu/login?url=https://search-proquest-com.ezproxy.liberty.edu/docview/1458312676?accountid=12085

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